Neurological diseases involve any disorder that affects the central or peripheral nervous system, which is composed of the brain and spinal cord, and all the other nerves in the body.
Neurological diseases are common and can result in an extremely wide range of symptoms, depending on the specific disorder and, especially where the brain is concerned, on the specific areas involved.
Neurological conditions such as Parkinson’s disease, motor neuron disease, and epilepsy result from damage to the brain, spinal column or peripheral nerves. Some neurological conditions are life threatening, with many severely affecting an individual’s quality of life. It is not always easy coping with the pressures of work when a person is affected by a neurological condition, and many employers are unaware of the ways in which their condition
might affect their work.
There are over 600 types of neurological conditions, which are broadly categorized (according also to a recent report of NHS UK) into:
- Sudden onset conditions (e.g. acquired brain injury or spinal cord injury),
- Intermittent and unpredictable conditions (e.g. epilepsy, certain types of headache, or the early stages of multiple sclerosis),
- Progressive conditions (e.g. motor neuron disease, Parkinson’s disease, or later stages of multiple sclerosis),
- Stable neurological conditions (e.g. post-polio syndrome, or cerebral palsy in adults).
In this section, we describe three neurological conditions: migraine, multiple sclerosis and stroke that are very frequent in working age.
The case of multiple sclerosis (MS)
Name: Mary
Age: 28 year old
Job: Employee
The case of Mary with multiple sclerosis
Mary has recently been diagnosed with multiple sclerosis. At times, Mary feels excessively tired and suffers from blurred vision in one eye.
Sometimes she gets tingling in some parts of the body; sometimes the numbness and the weakness involves her feet and Mary struggles to walk. Instead, there are long periods in which Mary is well and has no symptoms. Mary is right at the beginning of her working life and she is afraid that if she talks to her director about her disease, she would lose any chance of furthering her career in the company.
Multiple Sclerosis (MS)
1 What is it
Multiple sclerosis is a demyelinating neurodegenerative disease. Myelin is a fatty, protective covering that surrounds some nerve cells. Myelin is essential for the normal functioning of the nerves. In multiple sclerosis the damage and loss of myelin causes lesions in multiple areas (hence the “multiple” in the name) of the central nervous system. Clinical and experimental evidence indicates that a reaction of the immune system that triggers an attack on myelin. The first symptoms can arise at any age, but MS is typically diagnosed between the ages of 20 and 40 during an individual’s prime working stage of life. It also affects children (known as pediatric MS). The MS prevalence ratio of women to men has increased markedly in recent decades to 3:1.
2 Symptoms
The most common symptoms include:
- Fatigue and weakness (e.g. exhaustion that is perceived as effort in performing and sustaining even routine activities, loss of muscle strength)
- Visual disturbances (e.g. blurred or double vision)
- Mobility issues such as stumbling when walking, balance issues, an uneven gait or paralysis
- Sensitivity disorders (e.g. abnormal sensation or significant and persistent tingling, numbness of the limbs or loss of sensitivity to touch, difficulty in perceiving heat and cold).
People affected by multiple sclerosis have different symptoms based on the locations of the lesions in the central nervous system. The frequency of symptoms generally increases with the severity and duration of the disease even if, in some cases, there are no clear clinical correlations.
The condition is typically described as:
- Relapsing-Remitting
- Progressive
There is wide variety in the manifestation of disease and it is impossible to predict how each individual with MS will be affected. Most people can continue a relatively normal life many years.
3 Treatment
Although there is no definitive cure for MS, a range of treatments (Disease Modifying Therapies) is available, that can modify the course of the disease. these treatments reduce the incidence and severity of the relapses and the impact of symptoms.
The main therapies for MS are aimed at:
- Reducing the number of relapses and reducing their severity and duration. Intravenous steroids are often prescribed short-term to stop a relapse.
- Preventing relapses and preventing or delaying the progression of the disease. long-term therapies that have an effect on the immune system are available intravenously or taken orally.
Treatment must be tailored to the individual.
4 Psychosocial issues and impact of the disease on employment
MS has no predictable course and a relapse could occur at any time. Without the right support, some people with MS may develop anxiety and depression caused by this uncertainty. Depression may also be caused by MS and can be a side effect of some MS treatments. Treatment for mental health issues needs to be part of the management of the condition. Good symptoms management through an interdisciplinary approach can lead to improving the quality of life of people with MS, allowing them to continue to fulfill their professional and personal ambitions.
Some of the barriers to work ability that people with MS might face are practical, such as functional capacity, fluctuations in energy levels, fatigue and presence of other health conditions. Others are attitudinal, such as stigma, lack of confidence, negativity or anxiety among employers.
To manage workers with Multiple Sclerosis and help them continue working or returning to work, employers can promote some interventions.
- Support free and frank communication between the employer and the employee during the whole process: disclosure of a condition such as multiple sclerosis is not a requirement as it is important to respect and recognize individual’s rights to privacy, but it may be encouraged if it does not affect applicants and employees.
- Clear workplace health and illness policies, return to work planning, human resource intervention staff are important. During relapses, people with MS may need to stay at home for vary lengths of time. Planning how to manage absence together with the employee and a policy and support for returning to work are essential.
- Fatigue (a lack of energy not always relieved by sleep) is experienced by up to 80% of people with MS and can be the most disabling symptom of multiple sclerosis. Some treatments and therapies may also increase fatigue as a side effect. Fatigue can also affect productivity at work but there are strategies that can be used such as flexible working hours and smart work (options to work from home), arrangements and reasonable accommodation like accessible buildings, toilet facilities and designated rest areas for staff.
For further information, see:
European Multiple Sclerosis Platform (EMSP) – www.emsp.org/